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i
Making Sense of Euthanasia
A Foucauldian Discourse Analysis of Death and Dying
A thesis presented in partial fulfilment of the requirements for the degree of
Doctor of Philosophy in
Psychology
At Massey University, Palmerston North, New Zealand
Anne Beryl Ryan 2014
ii This thesis is dedicated in loving memory of three remarkable, inspirational women:
Mary-Anne Ryan (née O’Brien) 1896-1968 Monica Vera Ryan (née Isaacson) 1926-2009
Rebeca Anne Nathan (Bex) 1986-2013
iii
Abstract
A hugely contentious issue in society today is whether individuals have the right to choose when and how to die. This project examines how people make sense of euthanasia through both a genealogical perspective and an analysis of discourse. The first study presents a genealogy, a Foucauldian ‘history of the present’ that addresses the issue of how euthanasia has emerged as a possible solution to the problem of terminal illness. It investigates the conditions present at particular periods of time and a specific but disorderly collection of incidents that have enabled our present constructions of euthanasia. This genealogy challenges both the origins and functions of our present day ‘knowledge’ regarding euthanasia and the assumptions of self-evidence and inevitability that accompany prevailing discourses.
The second study involved interviews with 28 healthy people from the general population in Aotearoa/New Zealand to explore how they talked about and made sense of death, dying and euthanasia. A Foucauldian discourse analysis of the data revealed meanings of euthanasia that drew on three categories of construction: identity, reciprocation, and burden and duty. The discourses that enable these particular meanings of euthanasia to prevail in our society today and be accepted as ‘common sense’ provide the potential to act in certain ways, while marginalising alternative practices. The way in which people are positioned within these discourses will inevitably shape their understanding of themselves and the world and are pivotal to decisions regarding euthanasia. The power implications of these discursive constructions for vulnerable groups in society are considered in light of the euthanasia debate.
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Acknowledgements
This research was approved by the Massey University Human Ethics Committee (Southern B, Application 10/38). However, it would not have been possible without the generous contribution made by the 28 participants of the study. Their openness, honesty and thoughtful reflections on death, dying and end-of-life decisions were invaluable to my understanding of ‘how people make sense of euthanasia’. In addition, the expertise and encouragement of my two supervisors, Professor Mandy Morgan and Associate Professor Antonia Lyons was instrumental in guiding the project to fruition. Their supportive mentoring was greatly appreciated.
I also wish to acknowledge with sadness the sudden and unexpected passing of Pā Gilbert Knowles (Kaumātua Ngāti Kauwhata/Ngāti Raukawa; Āpotoro Rēhita Hāhi Rātana) during the course of this research project. The advice and guidance he provided for this and other research was valued immensely and above all his personal support and friendship will be greatly missed. Ka hinga te totara i te wao nui a Tāne. It is also with grateful thanks that I recognise the support of Whāea Piki MacFayden who contributed so selflessly to early discussions around the research topic and to recruiting and organising Māori focus groups.
Her readiness to assume the role of Kaumātua Advisor following Pā Gilbert’s passing was greatly appreciated.
Finally, I want to thank my husband Richard and children, Tahuora, Hohepa, Ryan, Shayne, Connor and Caitlin for their patient understanding and endurance of my PhD journey.
Ehara taku toa, he takitahi, he toa takitini
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Prologue
NORMA
I’m putting up 30 mgs over 24 hours ... even though she’s unconscious from the morphine she’s had already.
LESLEY
She was unconscious before I gave her the morphine.
Norma finishes with the syringe and turns to face Lesley.
NORMA
And you gave it for pain?
LESLEY Yes ... I guess...
NORMA
Unconscious people don’t feel pain. To give that much is to attempt...
LESLEY (interrupting) Euthanasia?
NORMA
(taking a sharp breath)
Euthanasia is illegal in this country.
They are facing off against each other, both deadly serious.
LESLEY
But it’s cruel ... she’s been through enough ... she’s dying ... there’s no hope anymore...
(From “...to die like a dog...” Martin, 2002, p. 160-161)
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Table of Contents
Dedication ii
Abstract iii
Acknowledgements iv
Prologue v
INTRODUCTION 1
CHAPTER ONE Critical overview of euthanasia literature 7 Introduction 7
Definitional issues and terminology 8
Incidence and prevalence 13 The ‘slippery slope’ and vulnerable groups 17
Attitudes 21
Representations of a good death 27
Media discourses 29
Conclusion 30
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CHAPTER TWO Theoretical framework 32
Introduction 32
Social constructionism 33
Foucault 35
Discourse/knowledge/power 36
Disciplinary power 37
Subjectivity 40
Governmentality 43
A society of security 44
Conclusion 46
CHAPTER THREE Gesture to genealogy 47
Introduction 47
The present 49
Historical reflections on self-destruction 57
Medicalisation 62
Eugenics, euthanasia and civil rights 64
Neo-liberalism and economics 66
Conclusion 68
CHAPTER FOUR Method 69
Introduction 69
The researcher 70
Participant recruitment 71
Research with Māori 72
Data collection 74
Individual pair and group interviews 75
Further safety and ethical issues 78
Procedure 79
viii The participants 80
Transcription 83
Analysis 83
Conclusion 87
CHAPTER FIVE Identity 89
Introduction 89
Physical appearance 90
Leaky bodies 96
Mind/body dichotomy 102
Alive but not living 106
Dead yet still living 111
What to do? 114
Conclusion 117
CHAPTER SIX Reciprocation 119
Introduction 119
Potential and value to society 120
A fair deal 125
Kaumātua reciprocation 128
Religious reciprocity 130
Conclusion 133
CHAPTER SEVEN Duty and burden 135
Introduction 135
Death’s dilemma 136
Intergenerational responsibility 141
Burden 145
Autonomy and independence 150
Conclusion 155
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CHAPTER EIGHT Discussion 156
Introduction 156
Reflections on methodological approach 157
Genealogy 160
Discursive analysis 164
Conclusion 169
REFERENCES 173
APPENDICES
Appendix A: Letter of support 187
Appendix B: Interview schedule 188
Appendix C: Information sheet 189
Appendix D: Consent form (individual) 194
Appendix E: Consent form (joint interview/focus group) 195
Appendix F: Transcription key 196
Appendix G: Māori/English translations 197
